MACPAC Releases 2017 Edition of MACStats Medicaid and CHIP Data Book

December 2017 edition includes information on new adult group enrollment and spending

Today, the Medicaid and CHIP Payment and Access Commission (MACPAC) released the December 2017 edition of the MACStats: Medicaid and CHIP Data Book. In addition to its annual update of national and state-specific data for Medicaid and the State Children’s Health Insurance Program (CHIP), this year’s edition of the MACStats data book for the first time presents state-by-state enrollment and benefit spending for adults who became eligible for Medicaid under the Patient Protection and Affordable Care Act (Exhibit 23).

“MACStats data provide a detailed look at Medicaid and CHIP from every angle—program enrollment and spending, benefits, as well as beneficiary health, service use, and access to care. This data book is an indispensable resource for federal and state policymakers, reporters, researchers, health care stakeholders, and anyone who seeks to understand Medicaid and CHIP’s impact across the country and in each individual state,” said MACPAC Chair Penny Thompson.

MACStats compiles data on Medicaid and CHIP that come from multiple sources and are often difficult to find. The 48 tables and figures, published annually in December as well as updated regularly on macpac.gov, contain data on national and state Medicaid and CHIP enrollment, spending, and beneficiaries’ health, service use, and access to care.

Highlights from this year’s edition of MACStats include:

Medicaid and CHIP accounted for 17.5 percent of national health expenditures in 2015, less than either Medicare (20.2 percent), or private insurance (33.4 percent).

The share of the federal budget devoted to Medicaid and Medicare has grown steadily since the programs were enacted in 1965. Even so, Medicaid’s share (9.6 percent) in 2016 was smaller than Medicare’s share (15.3 percent). Medicaid and CHIP enrollment grew less than 1 percent in 2017.

Over 40 percent of all individuals enrolled in Medicaid in 2016 had family incomes below 100 percent of the federal poverty level (FPL), and more than 60 percent had incomes of less than 138 percent FPL, the eligibility threshold in states that expanded Medicaid to childless adults.

Children have had the largest enrollment increase in absolute numbers since fiscal year (FY) 1975. Individuals qualifying for Medicaid on the basis of disability—the smallest eligibility group in FY 1975 in terms of absolute numbers—had the largest percentage increase in enrollment, quadrupling over this nearly 40-year period.

Almost half (46.3 percent) of Medicaid benefit spending in FY 2016 was for payments to managed care plans, up from 43.1 percent in the prior year.

Disproportionate share hospital (DSH), upper payment limit, and other types of supplemental payments accounted for over half of fee-for-service payments to hospitals in FY 2016.

Both children and adults whose primary coverage source was Medicaid or CHIP reported seeing the doctor slightly less than those with private coverage, but more than those who are uninsured. They were more likely to have trouble finding a doctor or to experience delayed care than those with private coverage. However, adults with Medicare reported the highest rates of delayed care and unmet need due to cost, not counting adults who were uninsured.

The Medicaid and CHIP Payment and Access Commission is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on a wide array of issues affecting Medicaid and CHIP. For more information, please visit macpac.gov.

MACPAC

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About MACPAC

MACPAC serves as an independent source of information on Medicaid and CHIP issues that include payment, eligibility, enrollment, coverage, access to and quality of care, and the programs' interaction with Medicare and the health system generally. MACPAC’s authorizing statute requires it to submit two reports to Congress annually. The Commission holds public meetings and consults with state officials, congressional and executive branch staff, beneficiaries, health care providers, researchers, and policy experts to carry out its work.